不同入路枕部头皮神经阻滞在乙状窦后入路开颅手术中的应用  

Application of Occipital Scalp Nerve Block by Different Approaches in Craniotomy Via Retrosigmoid Approach

作　　者：王洪萌[1] 李敏捷[1] 林婷[1] 林群[1] WANG Hongmeng;LI Minjie;LIN Ting;LIN Qun(Department of Anesthesiology,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院麻醉科,福州350005

出　　处：《福建医科大学学报》2020年第3期181-185,共5页Journal of Fujian Medical University

基　　金：福建省中青年教师教育科研项目(JAT160196)。

摘　　要：目的对比不同入路枕部头皮神经阻滞在乙状窦后入路开颅手术围术期中的镇痛效果。方法收集经乙状窦后入路行听神经瘤、岩骨背侧脑膜瘤、胆脂瘤等桥小脑角区病变的神经外科显微手术患者40例,随机分成经典入路(C组,n=20)和头下斜肌入路(O组,n=20),分别记录切皮前、切皮时及切皮后5,10,15,30,60,90,120,150,180 min的平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)及肺泡最低有效浓度(MAC);记录麻醉过程中追加的舒芬太尼用量;记录拔管后1,2,4,8,12 h的VAS评分和Ramsay镇静评分。结果两组患者的MAP,HR,BIS及MAC值在术中各时点组间比较均无明显差异(P<0.05);C组中有5例患者术中切皮做入路分离时需追加舒芬太尼,两组比较有显著差异(P<0.05);两组患者术后各时点的VAS评分均较术后2 h增高(P<0.05),且术后8,12 h C组VAS评分明显高于O组(P<0.05);两组患者术后4,8,12 h的Ramsay评分较术后1 h显著降低(P<0.05),且C组明显低于O组(P<0.05)。结论头下斜肌入路的枕大、枕小神经阻滞能为乙状窦后入路开颅手术提供更长时间的术后镇痛,并能减少术中舒芬太尼的用量。Objective To compare the analgesic effect of different approaches of occipital scalp nerve block in the perioperative period of retrosigmoid approach craniotomy.Methods 40 patients with cerebellopontine angle lesions,such as acoustic neuroma,petrous dorsal meningioma and cholesteatoma,were randomly divided into classical approach(group C,n=20)and oblique capitis inferior approach(group O,n=20).The MAP,HR,BIS,MAC values of before,during and 5,10,15,30,60,90,120,150,180 min after skin cutting were recorded;the dosage of sufentanil added during anesthesia;the VAS scores and Ramsay Sedation scores at 1,2,4,8,12 h after extubation were recorded.Results There was no significant difference in MAP,HR,BIS and MAC between the two groups at each time point(P>0.05);5 patients in group C needed sufentanil to be added during incision and separation,and there was significant difference between the two groups(P<0.05);VAS scores of the two groups at each time point increased gradually than those after 2 h(P<0.05),and 8,12 h after operation the VAS score of group C was significantly higher than that of group O(P<0.05);the Ramsay score of the two groups at 4,8 and 12 h after operation was significantly lower than that after 1 h(P<0.05),and group C was significantly lower than group O(P<0.05).Conclusion The block of greater occipital and lesser occipital nerves through oblique capitis inferior approach can provide longer postoperative analgesia for craniotomy via posterior occipital approach,and can reduce the amount of sufentanil during the operation.

关 键 词：神经传导阻滞 脊神经 

分 类 号：R614[医药卫生—麻醉学] R745[医药卫生—外科学]